Pancreatic surgery in Nagoya University
- VernacularTitle: Нагояа их сургуулийн нойр булчирхайн мэс заслын өнөөгийн байдал
- Author:
Tsutomu FUJII
- Publication Type:journal article
- From:Innovation
2014;8(4):134-135
- CountryMongolia
- Language:English
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Abstract:
Background: Nagoya University is one of the high-volume centers of pancreaticsurgery in Japan. We experienced about 800 pancreatectomies between 2000and 2013. Furthermore, we have reported many papers which have contributedto development of pancreatic surgery. The following are procedures that havereported its usefulness from our department.1. Mesenteric approach in surgery for pancreatic cancerAkimasa Nakao, our previous professor, developed ‘the mesenteric approach’procedure in 1993, which was mentioned by subsequent authors as the ‘arteryfirstapproach’. This procedure facilitates radical lymph node dissection aroundboth the superior mesenteric artery and the portal vein (PV), and can reducetension of a direct end-to-end anastomosis of PV, compared with conventionalapproaches.2. Portal vein resection and Anthron catherter bypassProfessor Nakao developed an antithrombogenic bypass catheter of the portalvein. With this catheter, mesenteric venous blood can be bypassed to the systemiccirculation or intrahepatic portal vein to prevent portal congestion or hepaticischemia during portal obstruction or simultaneous obstruction of the hepaticartery. This catheter was useful in cases of hepatobiliary and pancreatic cancersurgery combined with portal vein resection.3. Modified Blumgart anastomosis (Nagoya method) for pancreatojejunostomyRecently, we established a simplified version of the Blumgart anastomosistechnique, and reported as the modified Blumgart anastomosis. Placement ofsutures between the pancreatic parenchyma and the jejunum risks leakage ofpancreatic juice from the needle holes or laceration of the pancreatic parenchyma,especially in patients with soft pancreas. The original Blumgart anastomosis usedfour to six transpancreatic/ jejunal seromuscular sutures, and our method usedonly one to three. Our method also completely covered the pancreatic stump withjejunal serosa because of the modified lateral suture through the seromuscularlayer of the jejunum. These modifications resulted in more favorable outcomes.4. Subtotal stomach-preserving pancreatoduodenectomy (SSPPD)We reported the usefulness of SSPPD in terms of the perioperative outcomesand long-term nutritional consequences. We compared three PDs (conventionalpancreatoduodenectomy with a distal gastrectomy (cPD), pylorus-preservingpancreatoduodenectomy (PPPD), and SSPPD), and found that the incidenceof delayed gastric emptying was significantly higher in the PPPD group thanin the cPD and SSPPD groups (27.3%, 5.8%, and 5.4%). The serum albuminconcentration and total lymphocyte count at 1 year postoperatively weresignificantly higher in the SSPPD group than in the PPPD group. We believe thatpreservation of the pyloric ring without vagal innervation has little significance,and that SSPPD with better perioperative and long-term outcomes is more suitableas a standard procedure for patients with pancreatic head cancer.
